title: Hyperinsulinemic hypoglycemia with nesidioblastosis: histologic features and growth factor expression.
abstract: Hypoglycemia secondary to nesidioblastosis is rare in adults, and the pathogenesis of this condition is unknown. To determine factors leading to nesidioblastosis in adults, we analyzed 36 cases of nesidioblastosis including 27 cases of postgastric bypass nesidioblastosis and 9 cases of idiopathic nesidioblastosis in adults by immunohistochemistry using antibodies to insulin-like growth factor 1, insulin-like growth factor 2 (IGF2), insulin-like growth factor one receptor-alpha epidermal growth factor receptor, transforming growth factor-beta1 and 2, and transforming growth factor-beta receptor type 3. Fifty-two surgically excised pancreatic specimens from patients with benign exocrine tumors and no evidence of hypoglycemia were used as controls. There was increased IGF2, insulin-like growth factor receptor 1 receptor-alpha and transforming growth factor-beta receptor 3 expression in islets from nesidioblastosis patients compared to controls. Peliosis-type vascular ectasia was more common in nesidioblastosis patients compared to controls. These findings suggest that increased production of growth factors and growth factor receptors may contribute to the development of nesidioblastosis in adults.
authors.affiliation: Division of Anatomic Pathology, Mayo Clinic, Rochester, MN 55901, USA.
authors.forename: Kandelaria M
authors.initials: KM
authors.lastname: Rumilla
authors.forename: Lori A
authors.initials: LA
authors.lastname: Erickson
authors.forename: F John
authors.initials: FJ
authors.lastname: Service
authors.forename: Adrian
authors.initials: A
authors.lastname: Vella
authors.forename: Geoffrey B
authors.initials: GB
authors.lastname: Thompson
authors.forename: Clive S
authors.initials: CS
authors.lastname: Grant
authors.forename: Ricardo V
authors.initials: RV
authors.lastname: Lloyd
mesh_terms: D000328:Adult; D001808:Blood Vessels / Q000473:pathology; D016022:Case-Control Studies; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects; D006801:Humans; D006946:Hyperinsulinism / Q000209:etiology / Q000378:metabolism / Q000473:pathology*; D007003:Hypoglycemia / Q000209:etiology / Q000378:metabolism / Q000473:pathology*; D007150:Immunohistochemistry; D017403:In Situ Hybridization; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D007335:Insulin-Like Growth Factor II / Q000032:analysis; D036341:Intercellular Signaling Peptides and Proteins / Q000032:analysis* / Q000235:genetics; D007515:Islets of Langerhans / Q000098:blood supply / Q000737:chemistry / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D046768:Nesidioblastosis / Q000209:etiology / Q000378:metabolism / Q000473:pathology*; D011509:Proteoglycans / Q000032:analysis; D017526:Receptor, IGF Type 1 / Q000032:analysis; D018125:Receptors, Transforming Growth Factor beta / Q000032:analysis; D012307:Risk Factors; D053773:Transforming Growth Factor beta1 / Q000032:analysis; D053781:Transforming Growth Factor beta2 / Q000032:analysis
chemical_list: D036341:Intercellular Signaling Peptides and Proteins; D011509:Proteoglycans; D018125:Receptors, Transforming Growth Factor beta; D053773:Transforming Growth Factor beta1; D053781:Transforming Growth Factor beta2; C071736:betaglycan; D007334:Insulin-Like Growth Factor I; D007335:Insulin-Like Growth Factor II; D017526:Receptor, IGF Type 1